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INS F.CTION NOTICB
City of Tigard Building Departm'ent
1,312S SW Hell Blvd. Tigard, Oregon 97223 �
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(Aec-
InspeCtion Line O-Phone)s 639-4175 Business P�one�s -/�
Inspeotioni ►r 1'�X��—
Plbg. Undoralab Mach. Rough-in Appr/Sdwlk
Footing �,.
plbg. 'rop Out Oae Lin)
round.
Sewer 9
Framin d
post/Beam Struat. San.
Insulation
poet/Beam Mech. Rain Drain
p! t
„+„ t -Mach.
Clbq. Underfloor Mater Line Gyp. Dd.
'g."+ ,r'9
Timsi AN PH
Date Requentedst�.
Permit #t 7
]Address: "
BuildersY 4'�,p{�
THE FOLLOWING CORRECTIONS AAE RFQUIREDS
Inspector --�__�_—__ Date i �� t ;
—L-Ap,PRO%ID DISAPPROv6D APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSP4'CT_ION NOTICE
City of Tigard Building Department
13125 SP Hell Blvd. Tiyard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business P-hoonne�:” 6 1
Ins,,ection:�—L_s.-._ tt_ _ —� •-�.fC .[.�Dl�. i
Footing Plbg. Underalab _—ICe_�h. Rough—inAppr/Sdwlk
Found.
. Top Out Grs Line FINALt
Post/Ream Struct. ` San. Sewer Framing -Bldg.
Poet/Beam Hoch. Rain Drain Insulation
�ea,
Plbg. UnderfloorWater Lino Oyp. Bd.
Date Requested: Time: PH
_ -_ / M
C ^
Address:� Permit l e mjlT
7y-ei
Bu+L"x ti
TBE FOLLOWING CORRECTIONS ARE REQUIREDs
Inspecto / r
- sem___._ .�------------ Detet�#--
J'JAPPROVRD DISAPPROVED '^ APPROVED SURTE(- TO A VE
Cell For Reinsp
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•
IN_RECTIOt! NOTICE'
Ci
City of Tigard Building DeP�twsnt \
i
13125 SN Ball Give. Tigard, Oregon 97223
Inb ,ection Lint (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:.___-1 - l(J
Footing Plbg. Underal.ab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Cas Line FINAL:
�,4 ' t+;'� Poet/Beam 3truct. Saye. Sewer
-Bldg. ~
Poet/Beam Mach. Rain Drain Insulation
tj�jdrtrq � F alt -Plumb.
Plbg. Underfloor Water Line
OYp. Bd. -Mach.
t^ifiv
N
Date Requested:
�� lrty �, fid° 1� i �i i TiIDet AM PM
Addreea:� �� _2 _A6
x r Permit 1
� Yttt3lrrDsc:
THF, FOUAMINC CORRECTIONS ARE REQUIREDt
YVA
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Inspector: Date: k=4 ��
__"PROVED ^� DISAPPROVRD APPROVED
SUBJECT TO ABOVE
Call For Rainsp.
. CITY OF T
• COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hull Blvd.Tigard,Oregon 97223.8199 (503)639.4171 PERMITMANE R F RM I T
PERMIT #. . . . . . . : ms,r940425
6,39-4171 DATE ISSUED: 11/17/94
PARCEL_: c1S114AB--•04601Z1
SI'('E ADDRESS. . . : 11194120 SW IhILL_I N DR
SUbD I V I S I ON. . . . : KNEEL AND ESTATES ZONING: R-4. 5
BLOCK. . . . . . . . . . . L.01.. . . . . . . . . . . . . : 35 �
BUILDINC7
REISSUE: DWELLING UNITS- 1 BASEMENT. . . . . . . . .0 s f
CLASS OF WORK. :ADD BEDRMS:0 BATHS: 1 GARAGE. . . . . . . . . . ..0 S
TYPE OF UISL. . . :SF F=LOOR AREAS-_-- •-_. REOU I RIND SETBACKS-
TYPE
ETBAC:KS-TYPE OF' CONST. :5N FIRST. . . . : 17 S LEFI, . 0 ft RIGHT. :O ft
OCCUPANCY GRP. :R3 SIWC:OND. . . :0 5f F=RONT. s 0 ft REAR. . :O ft
STORIES. . . . . . . : 1 r"INBSMENT:0 5f REQUIRED- _______
HE:IGH1.. . . . . . . . : 0 ft T01-AI...--- - --: ]. 7 Sf 11OK1' DETECTORS. :
FLOOR LOAD. . . . :40 pSf VALUE. . . . . 311100 PARK .NG SPACES. . :0
Remarks : ADDITION OF ONE BATH IN GARAGE
PLUMBING
SINKS. . . . . . . . . . :0 F'I._OOR DRi1INS. . . . :0 BACKFLOW PRI-VNTRS. . :0
L AVAI'ORIES. . . . I " i WATER HEATERS. . . :0 TRAPS. . . . . . . . , . . . . . ej
TUB/SHOWERS. . . . :0 LAUNDRY TRAYS. . . :17.1 CATCH BASINS. . . . . . . :Q)
WA'TE:R CLOSETS. . : 1 SEWER LINE: (ft ) . :0 GREASE TRAPS. . . . . . :0
DISHWASHERS. . . . :0 WATER L_INE (ft ) . :it) OTHER F I X TURES. . . . . -0
GARBAGE DISP. . . :0 RAIN DRAIN (ft ) . :O
WASH INC MACH. . . :0 SF RA I i4 r"RA I NS. . ,0
MECHANI!,AL - __.__.- .------._-_______---___._._______. FEES •---.-_.___..________..._.
FUEL '1 Y1='ES-- _---_.______ UNI1'' HTR'S. . :0 t yue amount by ciat e recpt
VENTS . . . . . .0 BFIRT $ 44. 50 KAR 11/10/94 9b -:.5P61f1
MAX INPUT.Vl 1.3 TU V!�N FANS. . : 1 DPLC $ 213. 93 KAR 11/1.171/94 94--25BE,18
FURN ( 10111K . . :0 HOODS. . . . . . :0 B5PC $ : . ,amu KAR .11/10/94 94-25861b
TURN ) =10170 . . :0 WOODS I-OVES. :0
r LCIi•R FURN. . . . :0 CLO DRYERSi. : 0
BOIL/CMP ( 3HP:0 OTHER UNITS-0
GAS OUTLE=TS:0
JOSE:FIF•i SARANC I L{
9,40111 '.:3W M I LLEN DR
TIGARD OR 97224
Prione #: 50,3--624-2165
Contractor:
OWNER
Phone tf:
Req
$ 75. 66 TOTAL.
This pereit is issued subject to the regulations contained in the - - --- - REUUIRED INSPECTIONS -- - -
Tigard Municipal Cade, State of Ore. Specialty Codes and all other FILM/Under-fIocr Bui ldinq Final
applicable laws. All work will be done in accordance with approved Mechanical Insp
plans. This pet-sit will expire if work is not started within 180 PlUmh "fop Uut
days of issuance, or if work is suspenr ed for• Yore 180 days. F• l'eam i n g l n s p
rIns�.tl�-atian 1np
mittee iiynati�
GypNoar-d Inyp
r Mechanic:al Final
Faed Bye LG - _ F'1l_Imb F inal
Laii tot- Inspection .s - --
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• - !diri9—Per-mit Application B! - r��I
•
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobstte Address. qQ C)d � lh M I LE N NZ• T I �
Subdivision: �_
I�J�I EELArJI��STA�TES Office Use Only
Lot#
`l Planck/Rec # I
Valuation:
� Permit# . "
CDrrar Lot? Y ON -�-`"
Reissue oi' _
FI,ig Lot? Y
Ma & TL#
P
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Owner: _Ast-Fk ADPrM y KAP L SiAIZAK)CApprovals Required
Address: 9a DD e,L 1 M i uEQ DQ Planning
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TI UQ o►1,72-14
- Engineering
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Phone: 503- (y 2.4- Z I&S — Other _
Contractor: —)OSEPA Ar>w $Ar2k-.tJCI IC _ Items Required
Address: X400 SU1 MIL-L4FV,) D(2• subcontractors
-T1 D 2 M-72 2 L4 Truss Details
Phone: a)3- 49 Z4` Z I(o5 Other
Contractor's License # b")Ot1(.�
(attach copy of current Oregon license)
Contact Name & Phone:
Subcontractors: Architect/Ergineer:
Plumb!ng: IL�A� _ Address:
' EtectY�cad: tl,�Gt-
-AAssi�anisai;
(attach copy cf current OR Contractor's License)
Phone:
JOB DESCRIPTION: 2 bath r'nom aIterafI'Gr)
i
Applicant Signature & Pone number
Received by: ��'i Date Received:
NAWORDICOMDE"ESAPP
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Permit# Account Description Amount Amt. Pd. Bal. Due
�/�%(LOV' Bldg. Permit (BUILD) 41 �� _l����) � ' •
Plumb. Permit (PLUMB) _
Mech. Permit (MECH)
i
State Tax (TAX)
s
Bldg: _
Plumb.
i
I Mech:
Plan Check (PLANCK)
i
Bldg.-
Plumb:
ldg:Plumb:
I
I Mech:
_ Sewer Connection (,S'�A/USA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC) Y __
Residential TIF (TIF-R.)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1) _
Institutional TIF' (TIF-IS)
Office TIF (TIF-0)
Water QUality (WQt IAL)
i
Water Quantity (WQ(JANT)
f
Fire District (FIRE)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERrLAN)
Erosion Planck/COT (EROSN)
TCTALS:
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Permit#: �?_j
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Address:
_;•.• Issued by: _E c J Date: __ 7
Statement: Information Notice io Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This,statement is required
,For residential building, electrical, mechanical, and plumbing permits. Licensed
orchitect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blankp and initial boxes 1 and 2, and either box 3A or 3B:
1. 1 own, reside in, or will reside in the completed structure. U
El2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
❑ 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
313. 1 will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
1 herby certify that the above information is correct and that 1 have read and do understand the Information
Notice to Property Owners about lp7ction Responsibilities on the reverse side of this form.
Wz
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7 �
( i nature of a 't applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction, Responsibilities
w
Note: This Wor►nation Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5),
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, Mw
you can prevent many problems by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILITIES:
I
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
j constru,tion or improvement of a residential structure,you will,in most instances,be ruled to tie an employer and the people
you hire will be employees. As the employer,you must comply with the following:
Oregon's withholding tax law: As an employer,you must withhold income taxes from employee wages at the time employees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information,call the Oregon Dept.of Revenue at 945-8091.
Unemployment insurance tax: As an employer,you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information,call the Oregon Employment.Division at the Department of Human Resources
at 378-3524.
,i
Workers'compensation insurance: Asan employer,you are subject to the Oregon Workers'Compensation Law,and must
obtain workers'compensation insurance for your employees. if you fail to obtain workers'compensation insurance,you may
he subjL,,to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information,
call the Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S.Internal Revenue Service: As an employer,you must withhold federal income tax from employees'wa�tes, You will be
t liable for the tax payment even if you didn't actually withhold the tax. For more information,call the Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for thi,nrojcct,you are respon.ihle for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as fulling tools,paint overspray, water damage From pipe punctures, tire,or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supeu vise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and Finish
trades,and to notify building officials at the appropriate times so they can perform the required inspections.
if you have additional questions, write or call the Construction Conti-actors Board f P(:)Box 14140,Salem,OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
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